Indian Journal of Plastic Surgery
An open access publication of Association of Plastic Surgeons of India
Users Online: 633  
Home | Subscribe | Feedback | Login 
  Navigate here 
  Search
 
  
 Resource links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (658 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed709    
    Printed7    
    Emailed0    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
LETTERS TO EDITOR
Year : 2016  |  Volume : 49  |  Issue : 3  |  Page : 429-430
 

A novel technique for continuous cooling till re-establishment of blood flow during major limb replants


1 Department of Plastic, Microvascular and Cosmetic Surgery, Specialist's Hospital, Kochi, Kerala, India
2 Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi, India

Date of Web Publication30-Dec-2016

Correspondence Address:
Rahul Bamal
Bamal Hospital, Rohtak - 124 001, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0358.197222

Rights and Permissions



How to cite this article:
Jayakumar R, Bamal R, Mandal A. A novel technique for continuous cooling till re-establishment of blood flow during major limb replants. Indian J Plast Surg 2016;49:429-30

How to cite this URL:
Jayakumar R, Bamal R, Mandal A. A novel technique for continuous cooling till re-establishment of blood flow during major limb replants. Indian J Plast Surg [serial online] 2016 [cited 2017 Jul 22];49:429-30. Available from: http://www.ijps.org/text.asp?2016/49/3/429/197222


Sir,

Although it is well accepted that amputated part should be preserved properly at a low temperature till the blood flow is re-established, how to do it while the surgery is on? It is still considered a challenge and a cause for frustration to achieve it in a sterile surgical field, especially while performing major limb replantations.[1],[2]

We present here a novel, easy and economic technique that according to authors should be able to address majority of issues of ongoing cooling during surgery.

Firstly, the crushed ice is filled in unsterile gloves and they are closed using a thread or rubber band. Then, a sterile double-layered polythene sheet is rolled and closed at one end and the gloves are laid down in a line by another person inside rolled polythenesheet. Afterwards, the sheet is completely rolled with the sterile surface exposed and other end is also closed. Now, a sterile cling sheet (bandages are less efficient) is used to completely seal this roll from end to end, and an ice pack is ready to be used in the sterile field [Figure 1]. We can alter the size and number according to our needs, and unused ones can be preserved in a freezer for future use during the surgery [Figure 2].
Figure 1: (a) Crushed ice, (b) unsterile glove for filling ice, (c) filled up unsterile gloves with ice, (d and e) sterile sheets being rolled and filled with unsterile packs, (f) sterile ice packs prepared and ready for use after being sealed with cling drape

Click here to view
Figure 2: (a) Sterile ice packs being used during surgery, (b) ice packs cooling the prepared amputated part for replantation

Click here to view


This method has been used on a bilateral upper thigh replant done at Specialist's Hospital, Kochi, India.. It was not successful as one limb had to be removed due to infective pseudoaneurysm of the femoral artery while other one developed venous thromboses. Both limbs were removed between post operative days 6 and 10 but the patient survived.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
O'Brien BM. Replantation surgery. Clin Plast Surg 1974;1:405-26.  Back to cited text no. 1
    
2.
Tamai S. Twenty years' experience of limb replantation – Review of 293 upper extremity replants. J Hand Surg Am 1982;7:549-56.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 

    

Site Map  |  Home  |  Contact Us  |  Feedback  |  Copyright and Disclaimer
Online since 11th March '04
Published by Wolters Kluwer - Medknow